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e7— <br /> NOTE: PULL ALL PERl, TS (SEPTIC, WELL, ETC—) 1"'�KE COPIES FOR FILE <br /> %%MPZI_PA--O <br /> LAND USE REPORT APP# 0- <br /> EHD RECEIVEDAPP.REFERRAL: f S �� COMPLETE & SUBMIT BY ;„'� <br /> A P. <br /> `/a o <br /> D4fFE d ` 0,[UTE", <br /> ATTN: G G1 <br /> SITE ADDRESS: <br /> 100-30 <br /> In completing the Land Use investigation, draw all Pu lic Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction. etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ic�c9cicicn+c�'e�r:ri'Lire+eJra'r�k�exh9c9c9r�r9e9ce+ck�F�cocdc�F�E�F�'ciF�Fic�Fk�F�Fic�FvFk�F9cdciric�i�cirir�dr�Fak��eltxxxx�r9cle9e�rx�rxx9eicic9ex4cireF9ekic�e�ctFxx <br /> Supervisor/Lead Senior Comments: <br /> yaow <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA II CHECK OFF LIST• Proo read ie ort? � Cgrrect .4iND USE# " <br /> EH 06 06 Rev 1/99 B '` Car'recl COQ f()? pLngged�n LA1V1 USEBOl1K� <br /> YDITION S �. <br />